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What Is Hypertension In Pregnancy

Home Blood Pressure Monitoring

Hypertension in Pregnancy

It is important to note that while home blood pressure monitoring may be important, the readings must be validated with those of the office sphygmomanometer. A systematic review of the accuracy of blood pressure devices in pregnancy noted that only some of the ambulatory monitoring devices pass validation protocols. Another study comparing consecutive blood pressures by validated and non-validated automated blood pressure cuffs to sphygmomanometer readings in 127 pregnant patients showed that 69% of systolic and 77% of diastolic readings were within 5 mmHg of their manual standard and recommended that patients validate their home monitors in the office prior to use at home.

What Is Gestational Hypertension And Why Does It Happen

Hypertension is defined as a blood pressure that is higher than 140/90. Severe hypertension is defined as a blood pressure that is higher than 150/110. Sometimes women who usually have a normal blood pressure will have hypertension during pregnancy. This is one of the most common complications of pregnancy. It happens in 5% of all pregnancies and 10% of first pregnancies. Women are at risk for gestational hypertension if they:

  • Are first time moms
  • Have sisters or mothers who had gestational hypertension
  • Are younger than 20 or older than 40
  • Had high blood pressure prior to pregnancy.

After week 20, hypertension can lead to pre-eclampsia, a severe condition that features high blood pressure and protein in the urine. To monitor you for gestational hypertension, your health care provider will check your blood pressure and measure the protein content of your urine. The results of these two tests will tell you whether you have gestational hypertension or are at risk for developing pre-eclampsia. If you have hypertension watch out for symptoms that may signal pre-eclampsia including, headaches, blurred vision, dizziness, nausea or vomiting, or shortness of breath. If you have high blood pressure prior to pregnancy, or factors that increase your risk of developing or worsening high blood pressure during pregnancy, you may benefit from taking ASA. You should take two 81 mg tablets at bedtime to be effective this must be started before 16 weeks of pregnancy.

Why Is High Blood Pressure A Problem During Pregnancy

If you have gestational hypertension, your healthcare provider will want to monitor you more closely to make sure your blood pressure comes down to normal and does not worsen. This is because untreated high blood pressure can pose risks to you and your baby.

In terms of complications, high blood pressure can cause:

  • Preterm delivery

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What Are The Different Forms Of High Blood Pressure During Pregnancy

High blood pressure complicates about 10 percent of all pregnancies. There are several different types of high blood pressure during pregnancy. These types vary in severity and impact on the body. The forms of high blood pressure during pregnancy include:

  • Chronic hypertension: High blood pressure which is present prior to pregnancy.
  • Chronic hypertension with superimposed preeclampsia: Preeclampsia, which develops in someone who has chronic hypertension .
  • Gestational hypertension: High blood pressure is noted in the latter part of pregnancy, but no other signs or symptoms of preeclampsia are present. Some women will later develop preeclampsia, while others probably have high blood pressure before the pregnancy.
  • Preeclampsia: A condition only found in the latter half of pregnancy and results in hypertension, protein in the urine, and generalized swelling in the mother. It can impact other organs in the body and also cause seizures .

When High Blood Pressure Occurs

Gestational Hypertension (pregnancy induced hypertension)

Blood pressure thats too high for too long can damage your blood vessels and your heart, and increase your risk of having a stroke.

For this reason, its important to understand what high blood pressure is. It usually develops over time.

It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity. Being overweight or obese also plays a role.

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Treatment Of Acute Hypertension In Pregnancy

Acute severe hypertension in pregnancy is a medical emergency requiring treatment to lower blood pressures within 30 minutes of confirmation to reduce risk of maternal stroke. According to the February 2015 ACOG Committee Opinion #623 Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Post-Partum Period, first line options for treatment include oral immediate-release nifedipine, IV labetalol, and IV hydralazine.

How Do They Treat Preeclampsia In Pregnancy

Preeclampsia is dangerous and can develop gradually or come on quite suddenly. There are mild and severe forms of preeclampsia, depending on the severity of the signs and symptoms. The only cure for preeclampsia is delivery of the baby, and specifically the placenta. Women with severe preeclampsia are at higher risk for developing seizures known as eclampsia. These women usually receive magnesium sulfate during labor as well as 24 hours after delivery to decrease the chance of seizures.

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Hypertension In Preeclamptic Patients

The NHBPEP Working Group Report on High BP in Pregnancy and the American College of Obstetrics and Gynecology guidelines recommend treatment in preeclampsia when the diastolic BP is persistently above 105110 mm Hg, but there is no official recommendation regarding a systolic BP threshold for treatment. Most experts agree that pharmacologic therapy should be initiated when the BP approaches 150/100 mm Hg, with the goal of preventing cerebral and cardiovascular events in the mother. If a woman has mild preeclampsia with normal laboratory tests, other than low-level proteinuria, management as an outpatient can be appropriate, provided that there are frequent outpatient visits and that fetal nonstress testing is favorable. The frequency of formal ultrasound testing depends on the clinical condition and is at the discretion of an obstetrician. In the setting of severe preeclampsia that is being managed expectantly in the hospital, daily ultrasounds for fetal well-being may be indicated.

How Can I Prevent Gestational Hypertension:

Hypertension and Pregnancy

Currently, there is no sure way to prevent hypertension. Some contributing factors to high blood pressure can be controlled, while others cannot. Follow your doctors instruction about diet and exercise. Some ways you can help prevent gestational hypertension include the following:

  • Use salt as needed for taste
  • Drink at least 8 glasses of water a day
  • Increase the amount of protein you take in, and decrease the number of fried foods and junk food you eat
  • Get enough rest.

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Different Types Of High Blood Pressure In Pregnancy

There are 3 types of high blood pressure during pregnancy:

  • Chronic hypertension: This is when you already had high blood pressure before you fell pregnant for example if you already had a medical condition such as kidney disease. Chronic hypertension also refers to when your high blood pressure is diagnosed in the first 20 weeks of pregnancy. Some women with chronic hypertension may develop pre-eclampsia when they are pregnant.
  • Pregnancy-induced hypertension: This is high blood pressure that is diagnosed after 20 weeks of pregnancy. It is also called gestational hypertension.
  • Pre-eclampsia: Pre-eclampsia is a serious condition that only occurs in pregnant women. As well as high blood pressure, it can also affect the kidneys, liver, blood and brain.

Can High Blood Pressure Affect The Baby

High blood pressure in pregnancy can prevent blood from flowing to the placenta. Because the baby doesnt get enough nutrients or oxygen, they are at higher risk of being low birth weight or being born prematurely.

For this reason, its very important that high blood pressure is picked up early and treated.

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How Is High Blood Pressure During Pregnancy Different From High Blood Pressure At Other Times

High blood pressure during pregnancy can impact the body in different ways than it normally would. Mothers with high blood pressure during pregnancy are at a higher risk of complications before, during and after the birth. Not only is the mothers health in danger, but the baby can be impacted by high blood pressure during pregnancy.

High blood pressure during pregnancy can affect the development of the placenta, causing the nutrient and oxygen supply to the baby to be limited. This can lead to an early delivery, low birth weight, placental separation and other complications for the baby.

What Are The Symptoms Of High Blood Pressure In Pregnancy

Pregnancy Induced Hypertension  Nursing Care and Management

Your blood pressure is an important indicator of your health. If your BP is too high, it can cause you to feel fatigued, jittery, and generally unwell.

Common signs that you have hypertension include tiredness, light-headedness, tightness in your muscles and feet, slow reaction times, and friction burns on the rug in your apartment.

Symptoms of high blood pressure during pregnancy include

  • Headaches,
  • Sudden weight gain, and puffiness around your face, hands or ankles.

If youre experiencing any of these symptoms, contact your doctor immediately.

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What Kinds Of High Blood Pressure Can Affect Pregnancy

Two kinds of high blood pressure that can happen during pregnancy:

  • Chronic hypertension. This is high blood pressure that you have before you get pregnant or that develops before 20 weeks of pregnancy. It doesnt go away once you give birth. About 1 in 4 women with chronic hypertension has preeclampsia during pregnancy. If youre at high risk for preeclampsia, your provider may treat you with low-dose aspirin to prevent it.If you have chronic hypertension, your provider checks your blood pressure and urine at each prenatal care visit. You may need to check your blood pressure at home, too. Your provider may use ultrasound and fetal heart rate testing to check your babys growth and health. Your provider also checks for signs of preeclampsia.If you were taking medicine for chronic hypertension before pregnancy, your provider makes sure its safe to take during pregnancy. If its not, he switches you to a safer medicine. Some blood pressure medicines, called ACE inhibitors and angiotensin receptor blockers, can harm your baby during pregnancy.During the first half of pregnancy, blood pressure often falls. If you have mild hypertension and took medicine for it before pregnancy, your provider may lower the dose of medicine you take. Or you may be able to stop taking medicine during pregnancy. Dont stop taking any medicine before you talk to your health care provider. Even if you didnt take blood pressure medicine in the past, you may need to start taking it during pregnancy.
  • Risks Of Hypertension For The Baby

    High blood pressure can increase the risk of poor birth outcomes, such as preterm delivery, smaller-than-average size, and infant death.

    High blood pressure affects the mothers blood vessels. This can decrease the flow of nutrients through the placenta to the baby, resulting in a low birth weight.

    Hypertension-related preterm delivery can result in health complications for the baby. These may include difficulty breathing if the lungs are not fully developed, for example.

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    The Different Types Of Hypertension During Pregnancy:

    High blood pressure can present itself in a few different ways during pregnancy.The following are the 3 common types of gestational hypertension:

    • Chronic Hypertension Women who have high blood pressure before pregnancy, early in pregnancy , or continue to have it after delivery.
    • Gestational Hypertension High blood pressure that develops after week 20 in pregnancy and goes away after delivery.
    • Preeclampsia Both chronic hypertension and gestational hypertension can lead to this severe condition after week 20 of pregnancy. Symptoms include high blood pressure and protein in the urine. This can lead to serious complications for both mom and baby if not treated quickly.

    How Is High Blood Pressure During Pregnancy Treated

    Hypertension During Pregnancy (Obstetrics – High Risk)

    High blood pressure during pregnancy can be treated in a variety of ways depending on the severity, cause and time of onset. Mothers with all forms of hypertension will need to be monitored closely. This could include more prenatal visits, ultrasounds, and other tests to ensure the babys well-being .

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    High Blood Pressure During Pregnancy

    Some women have high blood pressure during pregnancy. This can put the mother and her baby at risk for problems during the pregnancy. High blood pressure can also cause problems during and after delivery.1,2 The good news is that high blood pressure is preventable and treatable.

    High blood pressure, also called hypertension, is very common. In the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.3

    High blood pressure in pregnancy has become more common. However, with good blood pressure control, you and your baby are more likely to stay healthy.

    The most important thing to do is talk with your health care team about any blood pressure problems so you can get the right treatment and control your blood pressurebefore you get pregnant. Getting treatment for high blood pressure is important before, during, and after pregnancy.

    Potential Complication: Gestational Hypertension

    When you’re pregnant, it’s common to have high blood pressure. Up to 8% of pregnant women in the U.S. have high blood pressure, usually during their first pregnancies. If you first develop it when you’re expecting, it’s called gestational hypertension or pregnancy-induced hypertension .

    Most women with gestational hypertension have healthy pregnancies and healthy babies. But, high blood pressure during pregnancy can be a sign of other conditions that can be much more harmful. That’s one reason why seeing your doctor early and often is so important in keeping you and your baby healthy.

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    Meanings Of Study And Implications For Physicians And Health Providers

    The most recent UK Confidential Enquiry into Maternal and Child Health identified chronic disease as an underlying factor in preventable maternal deaths. Consequently, the first recommendation stated that Pre-pregnancy counselling services, . . . for women with pre-existing medical illnesses . . . are a key part of maternity services, supported by the National Institute for Health and Care Excellences guidelines for the management of hypertension in pregnancy. Furthermore, the American Congress of Obstetricians and Gynecologists recent practice bulletin recommends that women with chronic hypertension should be evaluated before conception to ascertain possible end-organ involvement. Systematic reviews and meta-analyses can provide data more readily inferable to the individual, but no large aggregate analysis of pregnancy outcome in women with chronic hypertension has previously been reported. This meta-analysis of outcomes can be used before pregnancy and antenatally by healthcare professionals advising women with chronic hypertension regarding possible adverse pregnancy events.

    Accessibility to healthcare professionals and facilitation of early referral will allow drug treatment to be optimised on an individual basis or enable reassurance regarding continuation of drugs that are safe in pregnancy, to reduce the risk of complications including cerebrovascular events.

    What Are The Symptoms Of Pregnancy

    Hypertension in Pregnancy

    The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may experience symptoms differently. Symptoms may include:

    • increased blood pressure

    Specific treatment for pregnancy-induced hypertension will be determined by your physician based on:

    • your pregnancy, overall health and medical history
    • extent of the disease
    • your tolerance for specific medications, procedures, or therapies
    • expectations for the course of the disease
    • your opinion or preference

    The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications. Treatment for pregnancy-induced hypertension may include:

    • bedrest .
    • hospitalization .
    • magnesium sulfate .
    • fetal monitoring may include:
    • fetal movement counting – keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.
    • nonstress testing – a test that measures the fetal heart rate in response to the fetus’ movements.
    • biophysical profile – a test that combines nonstress test with ultrasound to observe the fetus.
    • Doppler flow studies – type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.
  • continued laboratory testing of urine and blood .
  • medications, called corticosteroids, that may help mature the lungs of the fetus .
  • delivery of the baby . Cesarean delivery may be recommended, in some cases.
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    Medication For High Blood Pressure In Pregnancy

    There are several issues to keep in mind when considering medications for lowering your blood pressure while you are pregnant.

    First, your blood pressure will probably be less than it would be if you werent pregnant.

    Second, your blood pressure will be dropping rapidly if you are having a baby.

    So, if your goal is to minimize the risk of having a baby living in your house or at risk of getting seriously ill, a medication that lowers your blood pressure during pregnancy may not be the best option for you. so its important to discuss them with your doctor before installing

    Can High Blood Pressure During Pregnancy Be Prevented

    Since the cause of high blood pressure during pregnancy is not known, it is not a condition that can usually be prevented. In some women at high risk for developing high blood pressure, healthcare providers often recommend daily baby aspirin for prevention. High blood pressure during pregnancy can sometimes be managed and controlled with the help of a healthcare provider. However, this may often require delivery of the baby. Your blood pressure will be checked regularly during prenatal appointments. If you have any concerns about your blood pressure, speak with your healthcare provider.

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    How Is Preeclampsia Diagnosed

    Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high , especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.


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